Concussions and CTE

For years now, the NFL has received a lot of flak about the danger the sport of football puts on its players. The players are likely to tear, break, fracture or sprain something once in their football career. But the biggest danger the NFL gets berated for is the concussions that occur.

Dr. Dominique Duncan, a USC Assistant Professor of Neurology, says constant hits to the head and concussions cause movement in the brain, resulting in possible contusions (bruises), brain bleeding, swelling, blood clots in the brain, and temporary or permanent brain damage.

Scott Zuckerman, co-director of Vanderbilt’s Sports Concussion Center Research group, says the length of recovery time and the symptoms do not get worse with each progressive concussion one sustains. The recovery time and symptoms could be the exact same whether it is their first or fifth concussion.

Zuckerman also says it is hard to say if there is a set number of concussions that someone can sustain without any future consequences.

“Each person is very different with how they respond to a concussion,” Zuckerman said. “One person may have one or two concussions and they’re symptomatic and they decide not to return to their sport. Other people may have three, four, five and they recover appropriately and they’re able to return back to support school, life, etc. So everyone really has a very individual response to injury based on a host of personal past medical history.”

But recently, the joining of the words “football” and “CTE” have been prominent in the media. Duncan says CTE (chronic traumatic encephalopathy) is a progressive degenerative disease of the brain resulting from a history of repetitive concussions. Unlike concussions that may be reversible, CTE is a neurodegenerative disease, like Alzheimer’s disease, and gets progressively worse over time.

Dr. Bennet Omalu, a neuropathologist, and his researching team from Boston University published a study in 2005 on finding CTE in a former American football player, Mike Webster. Webster was a center for the Pittsburgh Steelers for fifteen seasons, a nine-time Pro Bowler and a Hall of Famer. He had died at the age of 50 after years of explosive behavior, paranoia and loss of memory.

This study made Omalu the first to discover and publish findings on CTE in a football player. A year later, he ran the same tests on former Steelers guard, Terry Long. He played for eight seasons, died at 45 and had a brain of a 90-year old. He died after drinking antifreeze. These studies are what started the backlash on the safety of football. And these studies were the subject of the major film “Concussion”.

But in 2010, the NFL gave the CSTE (Center for the Study of Traumatic Encephalopathy) at the BU School of Medicine a $1 million gift. This gift is to help fund and support the Center’s studies of repetitive brain trauma in athletes.

Dr. Michael Alosco, a postdoctoral fellow at Boston University’s Alzheimer Disease and CTE Center, says he and the BU team are not sure how likely it is for a football player to be diagnosed with CTE in their future, but they have recently conducted a study that tested this question out.

“We are currently conducting studies to evaluate risk factors for CTE and who is and who is not at risk,” Alosco said. “Our recent paper in JAMA in 2017 found CTE in 110 of 111 former National Football League players, 48 of 53 college tackle football players, and 3 of 14 high school tackle football players. Duration of football may play a critical role in the development of CTE but this needs to be formally tested.”

Zuckerman believes the correlation between football and CTE is an “availability cascade”, which in this case is when the general public views these widely publicized case reports of CTE and football players in the media and assumes that to be the rule in everyone.

“However, to really know the relationship between concussions and CTE, we need much better science,” Zuckerman said. “We need much longer studies and better control studies of all kinds of football players. So I would just caution people against making premature judgments against a diagnosis with CTE, which is very young, very immature and for which we need more data.”